SMS as an Incentive To Adhere (SITA)

描述（由申请人提供）：艾滋病毒护理需要高度的药物依从性，以达到最佳的临床结果，如减缓艾滋病的进展。青少年在坚持服药方面面临着特殊和独特的挑战。尽管有大量的干预措施旨在提高依从性结果，但很少有人关注在资源有限的环境中或青少年时期可持续的干预措施。制定提高青少年服药率的方法尤为重要，因为这一群体的艾滋病毒/艾滋病新病例增长最快。现有的干预措施往往需要稀缺的人力资源，限制了它们的实际使用。在资源有限的环境中，以可持续的方式调整传统干预措施的新方法非常重要，因为二线治疗往往过于昂贵或根本无法获得。最近发展中国家人口中移动电话覆盖率和拥有量的迅速增加，催生了基于移动电话的干预措施，以改善卫生服务的提供；已发现基于短信服务的干预措施可提高成年患者对抗逆转录病毒治疗的依从率。然而，由于目前还没有明确的证据表明它们的工作途径，因此需要对这项有前途的技术有更多的了解。拟议的研究“短信作为坚持的激励”（SITA）提出了明确基于社会认知理论（SCT）理论框架的使用短信的新方法。第一种干预是自我监控，即向参与者提供关于其坚持表现的反馈。传统上，这包括门诊就诊，占用提供者和患者的时间和资源；相反，SIT建议提供客观的、实时的信息，通过电子监测设备（Wisepill）通过每周短信发送给患者。这种反馈建立了自我效能感，这是SCT的一个关键概念，因此可能有助于提高依从性。第二个干预是基于SCT的社会学习概念。感知到的群体规范以及影响这些观念的干预措施，是对青少年健康行为的关键影响，是直接学习的替代品。这种方法不仅为患者提供他们自己的依从性信息，而且还提供参考（同伴）组的信息，从而适应移动健康环境。这项研究的首要目的，是与主要持份者举行焦点小组讨论，以订定短讯干预措施，以配合本地青少年的需要。第二个目标是一个小型的，为期6个月的随机对照试验，测试两个SITA干预组在常规护理的控制条件下，以确定哪种告知和激励药物依从性的方法能最好地实现其目标。第三个目标是综合吸取的经验教训，并与诊所和其他关键利益攸关方进行讨论。这种能力建设和知识转移活动是本研究的一部分，目的是在南非和乌干达更广泛地建立移动医疗知识，以便在当地产生和实施想法。

DESCRIPTION (provided by applicant): HIV care requires high medication adherence to achieve optimal clinical outcomes such as slowing the progression to AIDS. Youths face special and unique challenges to adherence. Despite a wealth of interventions designed to increase adherence outcomes, few have focused on interventions that are sustainable in resource-limited settings, or for the period of adolescence. Developing ways to increase adherence rates among adolescents is particularly important as this groups experiences the fastest growth in new HIV/AIDS cases. Existing interventions often require scarce human resources, limiting their practical use. Novel ways of adapting traditional interventions in a sustainable manner are important in resource-limited settings, where second-line therapy is often too expensive or altogether unavailable. The recent rapid rise in mobile phone coverage and ownership among developing country populations has spawned the advent of mobile-phone based interventions to improve health service delivery; short message service (SMS)-based interventions have been found to increase adherence rates to ART among adult patients. However, more knowledge about this promising technology is needed as currently no clear-cut evidence exists about the pathways through which they work. The proposed study 'SMS as an Incentive To Adhere' (SITA) proposes novel ways of using SMS messages that are explicitly grounded in the theoretical framework of Social Cognitive Theory (SCT). The first intervention is that of self-monitoring, i.e. providing participants with feedback about their adherence performance. Traditionally this involves clinic visits that take up provider and patient time and resources; SIT instead suggests providing objective, real-time information measured by electronic monitoring (Wisepill) devices sent to patients by weekly SMS. Such feedback builds self-efficacy, a key SCT concept and so may contribute to improved adherence. The second intervention is based on the SCT concept of social learning. Perceived group norms, and interventions that affect those perceptions, are a key influence on health behavior among youths, providing a substitute for direct learning. This approach is adapted to a mHealth environment by providing patients not only with their own adherence information but also that of a reference (peer) group. The first aim of the study is to hold focus groups with key stakeholders to tailor the SMS-intervention to the local needs of youths. The second aim planned is a small, six-month randomized controlled trial testing the two SITA intervention groups against a control condition of usual care to determine which method of informing and motivating drug adherence can best achieve its goals. The third aim is to synthesize lessons learned and discuss them with the clinics and other key stakeholders. The purpose of such capacity building and knowledge transfer activities part of this study is to build up mHealth knowledge at Mildmay and Uganda more generally to a point where ideas can be generated and implemented locally.